Dementia-Friendly Health Centre Assessment

© The King’s Fund 2014
Is your health centre
dementia friendly?
EHE Environmental
Assessment Tool
First edition
HEALTH
CENTRE

Is your health centre dementia friendly? © The King’s Fund 2014
The EHE assessment tools
In order to help as many health and care organisations
as possible to develop more supportive design for
people with dementia, the King’s Fund has developed a
suite of dementia friendly assessment tools. Tools are
available for wards; areas of hospitals where patients
are ambulatory such as clinics; care homes; extra care
housing and health centres.
Dementia friendly design
Many people with dementia, especially those with
Alzheimer’s disease, have difficulty in interpreting what
they see and might for example think that a shiny
floor is wet and or slippery. They may also struggle
to understand unfamiliar environments so providing
simple, cost effective, dementia friendly design
features will help to reassure them whilst they are in
the health centre.
Health centres
The proportion of people with cognitive problems and
dementia accessing primary care services is increasing.
If health centres are designed to be dementia friendly
it can significantly improve the experience for people
with dementia by reducing agitation and maximising
their independence and engagement in their care.
Dementia friendly design is likely to assist everybody
who uses the health centre to read and navigate
the building.
The term ‘health centre’ has been used to cover a wide
range of buildings from which primary and community
care services are delivered. It includes premises for
single handed and groups of GPs, spaces in which
community nurses and other health staff run clinics
or undertake minor surgery, and polyclinics. The tool
focuses only on areas that are accessible by patients
and visitors.
The environmental assessment tool has been designed
to be practical and easy to use. It focuses on those
aspects of the physical environment known to impact
on people with dementia. It assesses both the physical
environment (such as floor coverings and use of paint
colours) and the way that the environment encourages
people to behave and interact.
How to use the health centre assessment tool
The assessment tool can be used by a single individual
but involving others who have a different perspective,
for example; people with dementia or a carer, GPs,
clinical staff, practice managers or maintenance staff,
can offer valuable opportunities for gaining different
views on the care environment and how to improve
it. Completing the tool together can also encourage
constructive conversations about the philosophy and
purpose of care.
Date .......................................
Health Centre
..................................................
Assessment carried
out by......................................

The assessment tool contains seven sections and a
set of questions to prompt discussions. It should be
completed in full. Walk around the health centre/GP clinic
being assessed and consider each of the questions in
turn. Give each question a score out of five, where five
indicates that it is met completely and one indicates it is
barely met. If any of the questions are not relevant they
should be marked as not applicable N/A. For example if
people are only attending for short consultations the
building is unlikely to provide outside space and not all
centres will use electronic check-in systems.
A summary sheet has been provided at the end of the
assessment tool which should help pinpoint the areas
that might be considered for initial improvement. Notes
about how others have used the results, together with
The King’s Fund’s overarching design principles for
dementia friendly design, are reproduced at the end of
the tool.
How the tool was developed
The first assessment tool for the ward environment was
developed in collaboration with NHS trusts participating
in The King’s Fund’s Enhancing the Healing Environment
(EHE) programme. Since then over 70 care organisations
have been involved in field testing the tools.
The tools have been informed by research evidence,
best practice and over 300 survey responses from
those who have used the tools in practice. Each of the
sections draws on this evidence to develop a rationale
for effecting change in care environments. These
rationales also address the visuospatial problems often
associated with dementia.
For further details go to www.kingsfund.org.uk/
dementia
Before using the tools
Before carrying out the assessment please ensure that
all relevant management backing has been secured to
build support and commitment to the results.
It may also be useful to take photographs as these
can be used to mark progress and act as a record of
improvements. If photographs are taken all relevant
permissions need to be obtained.
If you would like to provide any feedback on the tool
or to contact us please email ehe@kingsfund.org.uk

Please give examples of good practice/
areas of concern
Questions
Please score each answer from 1 – 5
(1=barely met, 5=totally met)
Does the approach to the centre look and feel
welcoming?
Is the entrance well signed and easy to find?
Is there a ramp with handrails and is it clear of
obstacles/articles which may cause confusion
e.g. bicycles?
Does the centre give a good first impression i.e.
is it well lit, clean, tidy and cared for?
Is there an obvious main reception/enquiry
desk near the entrance?
If there are separate reception areas for some
services, are these easy to see and clearly
signed?
Are seating/waiting areas obvious?
Is there a choice of seating provided including
chairs with arms?
Is there space for those accompanying patients
to sit with them?
The environment
promotes meaningful
interaction between
patients, their families
and staff
Rationale
Being unable to find the entrance
and/or reception desk can
cause anxiety. Uncared for and
unwelcoming spaces can provoke
concerns in patients and their
relatives about standards of care.
The arrangement of furniture
provides clues as to the purpose
of the space. Seating that enables
carers to sit alongside the people
they are accompanying will reduce
agitation and older people are
likely to need chairs with arms.
1
A
E
D
C
B
F
G
H
I

Questions
Is the level of light comfortable and appropriate?
Is the lighting even e.g. without pools of light
and/or dark areas, stripes or shadows which
could be confusing and disorientating?
Is there good natural light?
Is there good colour contrast between the
chairs and the flooring?
Are there artworks to provide interest while
waiting?
Are views of nature maximised e.g. by having
low windows so people can see out from a
seated position?
Is there access to pleasant, safe outside space
e.g. garden, courtyard, or terrace?
Has planting been chosen to be non-toxic and
to provide interest throughout the seasons?
The environment
promotes
well-being
Rationale
Older people need higher light
levels and people with dementia
may interpret shadows or dark
areas as holes in the floor or
different levels and avoid or try
to step over them. Appropriate
artworks can provide interest
while waiting. Views and access
to nature promote well-being.
Planting should be colourful and
non-toxic.
2
areas of concern
A
B
F
H
E
D
C
G

Questions
Is there a separate quieter seating/waiting area
which could be used by people with dementia
and their carers?
Are there appropriate facilities to enable a
relative/carer to be present throughout the
consultation and episode of care?
Is any electronic check-in system large enough
so as to be easily visible?
Is the electronic check-in system easy to use?
Is the patient call display easily visible from
the seating area/s?
Is the patient call display separate from any
TV screen so as to avoid confusion?
Is water freely available and independently
accessible?
Are snacks and hot drinks available if patients
are spending a long time in the centre?
The environment
encourages active
engagement of
people with dementia in
their care
Rationale
People with dementia can
become very anxious in
unfamiliar environments
but being able to have their
carer with them throughout
is likely to be reassuring.
Noisy environments and
patient call display systems
which use TV screens can be
misinterpreted. Keeping people
calm will enable them to better
participate in their assessment.
Distress can be eased by
providing a quiet waiting area
or room. Avoiding dehydration
is an important part of caring
for people with dementia.
3
areas of concern
B
A
E
F
G
H
D
C

Questions
Is the flooring matt rather than shiny and
in a colour that contrasts with the walls
and furniture?
Could the lighting or natural light from windows
make the floor appear to be wet or slippery?
Is the lighting or natural light from windows
even e.g. without pools of light and/or dark
areas, stripes or shadows?
Is the flooring a consistent colour i.e. does
not have speckles, pebble effects, stripes or
patterns?
Are any threshold strips or floor mats between
areas in the same colour and tone as the
flooring?
Do the handrails contrast with the walls and
can they be grasped properly?
Are there small seating areas for people to rest
along any long corridors and outside the centre?
Are lift controls easy to understand and clearly
visible?
Are dead ends avoided by putting a chair or
artwork at the end of long corridors?
Are staircases well lit and are stair nosings in a
contrasting colour to enable the edges of the
steps to be clearly distinguishable?
The environment
promotes mobility
Rationale
Being able to walk
independently is important.
Safety can be enhanced by
providing handrails and small
seating areas where people
can rest. People with dementia
may interpret shiny floors
as being wet or slippery and
changes in flooring colour,
for example a dark floor mat,
as something to step over.
Speckles or pebble effects in
flooring could look like pieces
of litter. Interesting artworks
will encourage mobility as well
as helping people find their
way around.
4
areas of concern
A
D
F
E
C
B
I
J
H
G

Questions
Can the signs to the toilets be seen from
all areas?
Are all toilet doors painted in a single distinctive
colour and do they have the same clear signage?
Are the toilet seats, flush handles and rails in
a colour that contrasts with the toilet walls
and floor?
Are the toilet flushes, basins and taps of a
familiar design?
Are the taps clearly marked as hot and cold
and are they and the toilet flushes of traditional
design?
Are the toilet roll holders of familiar design
and can they be easily reached from the toilet?
On each floor is there access to a toilet big
enough to allow space for a wheelchair and
carers to assist with the door closed?
If sensor lights have been installed do they
allow sufficient time for completion of toileting?
The environment
promotes
continence and
personal hygiene
Rationale
Not being able to find the toilet
provokes anxiety and using the
same signs and door colours to
denote all toilets will help people
find them more easily. Ensuring
good colour contrast on sanitary
fittings will make toilets and
basins easier to see and use.
Traditional and familiar designs
will help ease anxiety and
promote self-care. Being plunged
into darkness if sensor lights go
out can be very frightening.
5
areas of concern
A
D
F
G
H
E
C
B

Questions
Do doors have a clear or transparent vision
panel to show where they lead to?
Are signs of a good size and a contrasting
colour and hung at a height (approximately
4 foot/1.2m) that makes viewing them easy?
Are signs denoting consultation room number
or name clear and easy to read?
Are signs placed at key decision points to assist
navigation through the building?
Have strong patterns been avoided in wall
coverings, curtains, furnishings and screens?
Is there a large face clock easily visible in all
areas?
Is there clear internal signage denoting the
name of the centre and its location?
Are there points of interest and way finding
clues throughout the centre e.g. different
colours or artworks used to denote each floor?
The environment
promotes
orientation
Rationale
People with dementia are likely
to become agitated in unfamiliar
surroundings and providing visual
clues and prompts, including
accent colours and artworks of
local landmarks, to help them find
their way around is particularly
important. Signs need to be
placed at a height where they
can easily be seen and should
be placed on doors, not beside
them. Strong patterns on walls,
curtains or furnishings can be
misinterpreted. Providing clocks
and signs indicating the name and
address of the centre will help
with orientation.
6
areas of concern
A
D
F
G
H
E
C
B

Questions
Are notices kept to a minimum to avoid
distraction and confusion?
Are spaces clutter free?
Has adequate space been provided for
wheelchairs and pushchairs?
Have noise absorbent surfaces been used e.g. on
floors and ceilings, to aid noise reduction?
Is background noise kept to a minimum?
Are the ways out/ fire exits clearly marked and
easy to see?
Are doors to ‘staff only’ areas disguised e.g. by
painting the doors and door handles in the same
colours as the walls?
Are all hazardous liquids and solids e.g. cleaning
materials, locked away?
The environment
promotes calm,
safety and security
Rationale
Clutter and distractions,
including notices, can cause
added confusion and should
be avoided. Noise can make
concentration difficult and can
increase anxiety. Locked doors
and window restrictors can lead
to frustration and anger when
they cannot be opened.
7
areas of concern
A
C
E
F
G
H
D
B

Please add your scores for each
criterion here

1 The environment promotes meaningful
interaction between patients, their families
and staff
2 The environment promotes well-being
3 The environment encourages active
engagement of people with dementia in
their care
4 The environment promotes mobility
5 The environment promotes continence and
personal hygiene
6 The environment promotes orientation
7 The environment promotes calm, safety
and security
A B C D E F G H I

Summary
How others have used their results
Evaluations of the tools indicate that people have already used their
results to:
• secure finance from their boards to improve the care environment
• influence their managers and estates colleagues to support change
• educate staff and help change attitudes
• improve signage, flooring and colour schemes as part of
maintenance programmes.
How the results might be used
Scores can be benchmarked against other health centres or more
widely to look at comparisons and to highlight particular priorities
for improvement. Remember it is often the simple things that can
make a big difference such as de-cluttering spaces or providing
small seating areas. Similarly a local photographic competition
can produce stunning artworks.
If there are low scores in a particular area, think what action can
be taken immediately and what actions need to be addressed
with others. If the scores are low overall this should help inform
discussions on the need for environmental improvements with
senior management in the organisation.

LEGIBILITY
Can be aided by ensuring
Clear sight lines
Discreet security measures
Even lighting
Matt, even coloured, flooring
Noise reduction
Uncluttered spaces
WAYFINDING
Can be helped by using
Accent colours
Artworks
Identification of beds,
bedrooms and social spaces
Signage – pictures
and text
OUTCOMES
Easing decision-making
Reducing agitation
and distress
Encouraging independence
and social interaction
Promoting safety
Enabling activities
of daily living
FAMILIARITY
Can be enabled by
Domestic scale seating
and dining areas
Personal and self care items
Photographs and memory boxes
Recognisable sanitary ware
Traditional crockery and cutlery
MEANINGFUL ACTIVITY
Can be encouraged by
providing
Books and games
Drinks and snacks
Gardens
Handrails
Interactive artworks
Memorabilia
Places to walk
Resting points
ORIENTATION
Can be supported by
Artworks that reflect
the seasons
Calendars
Large face clocks
Natural light
Outside spaces
Photographs of local scenes
Clear signs and signage
Views of nature
Visible staff
Overarching design
principles
The design principles focus
on promoting well-being and
independence rather than providing
detailed room by room guidance.
They have been developed as
a result of the EHE programme
and bring together best practice
in creating more supportive care
environments for people with
cognitive problems and dementia.
The principles are drawn from
a number of sources, including
research evidence and the learning
gained from changes tested in a
range of care environments.
www.kingsfund.org.uk/sites/files/
kf/EHE-developing-supportive-
design-for-people-with-dementia-
bibliography1.pdf
Each of the five sections contains
a list of design elements that are
known to support, encourage and
enable people with dementia in
care settings. It is unlikely that all
the elements can be addressed at
the same time unless a new build
or comprehensive refurbishment
is being planned. However, many
of the principles are simple, can be
introduced with very little financial
outlay and are known to be helpful
in creating a more supportive
physical environment for people
with dementia and those that care
for them.

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